HERS Request Form

1. HomeOwner Information

Project Address:(Required)

City & State:(Required)

Zip Code:(Required)

Homeowner Name:(Required)

Homeowner Phone:(Required)

Homeowner Email:(Required)

2. HVAC Installer Information

Contractors License #:(Required)

HVAC Installer Co. Name:(Required)

HVAC Installer Contact Name:(Required)

HVAC Installer Phone:(Required)

HVAC Installer Email Address:(Required)

3. Billing & Signature Information

Contact for Scheduling Test:(Required)

Registered CalCERTS User?(Required)

Responsible Party for Certificate Approvals?(Required)

Responsible for Payment?(Required)

Preferred Method of Payment?(Required)

4. Installation & Project Information

Project Type:(Required)

Installation Date:(Required)

Permit Number:(Required)

Permit Date:(Required)

Building Department:(Required)

Square Footage of Home:(Required)

Number of Bedrooms:(Required)

Duct System:(Required)

Heating System Type:(Required)

How Many New HVAC Systems?(Required)

Altered Heating Components:(Required)

Cooling System Type:(Required)

Altered Cooling Components:(Required)

Email of Person Ordering HERS Testing:(Required)


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